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From the 6/11/2021 release of VAERS data:

Found 352,386 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 157 out of 3,524

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VAERS ID: 1323535 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-08
Onset:2021-05-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fluoxetine, glipizide, lisinopril, oxybutynin, potassium, risperidone, simvastatin, sitagliptin, vitamin D
Current Illness:
Preexisting Conditions: cerebral palsy, hypertension, hyperlipidemia, overactive bladder, type 2 diabetes, depression.
Allergies: Sertraline, ciprofloxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received first Pfizer COVID 19 vaccine on 5/8/2021. Pt became ill with COVID and was admitted to the hospital for treatment on 5/15/2021.


VAERS ID: 1323633 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-17
Onset:2021-05-15
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Hyperglycaemia, Urinary tract infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lantus, amlodipine, aspirin, atorvastatin, coreg,
Current Illness:
Preexisting Conditions: Diabetes Type 2, CAD, COPD, CKD, CLL, HTN
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for hyperglycemia, UTI, and weakness


VAERS ID: 1323710 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Headache, Laboratory test
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antibiotic for acne and fluoxetine
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: EKG and lab work done at emergency room
CDC Split Type:

Write-up: Headache and chest pains


VAERS ID: 1323756 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was 11 years old at time of vaccination. Her mother falsified her age information on the consent form.


VAERS ID: 1323761 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Lymphadenopathy, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanfacine Vyvanse
Current Illness: No
Preexisting Conditions: No
Allergies: None known
Diagnostic Lab Data: Talked to nurses ; observation and told to take Advil and report to Pediatrician and other HCP
CDC Split Type:

Write-up: Pfizer- right lymph node behind ear become red and swollen; hot to the touch


VAERS ID: 1323779 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest and throat tightness


VAERS ID: 1323784 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Bacterial test, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MYCOPHONELOATE, TACROLIMUS, CALCITRIOL, VIT D, ZYRTEC, KEFLEX, LOESTRIN FE
Current Illness: NONE
Preexisting Conditions: S/P KIDNEY TRANSPLANT OCT 2007
Allergies: OXYCODONE, RED FOOD DYE
Diagnostic Lab Data: 5/17/21: HOSPITAL- SKIN/LESION CULTURE FOR VARICELLA - PENDING.
CDC Split Type:

Write-up: SMALL BUMPS/RASH WITH WHITE HEADS OVER BODY THAT BEGAN ON CHEST AND GROIN APPROX 6 HRS AFTER; PROGRESSED TO ENTIRE BODY WITHIN 24 HOURS- ITCHING. APPEARS AS CHICKEN POX.


VAERS ID: 1323975 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-11
Onset:2021-05-15
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram thorax abnormal, Platelet count normal, Platelet factor 4 decreased, Pulmonary embolism
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: drosperinone-ethinyl estradiol (yasmin) 3-0.03mg tablets, venlafaxine HCl ER 75mg tablets, metformin HCl ER 500mg tablets
Current Illness:
Preexisting Conditions: Obesity (BMI 37.27 kg/m^2), PCOS, right spontaneous pneumothorax in 2018 s/p thoracoscopy, apical bleb resection, apical pleurectomy and pleurodesis, anxiety/depression
Allergies: no known allergies
Diagnostic Lab Data: Chest CT on 5/15/2021 shows acute pulmonary artery emboli. PF4 without heparin = 0.087 on 5/16/2021. Platelets were 288 on admission (5/15)
CDC Split Type:

Write-up: The patient presented with chest pain on 5/15/2021. She had a 9 hour drive on 4/30/2021, and had the J&J vaccine on 4/11/2021.


VAERS ID: 1324080 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: none
CDC Split Type:

Write-up: about 5 minutes after administration pt fainted. pt was in the company of his mother who stated pt quickly regained consciousness. we offered to call the paramedics pt''s mother refused reassuring us her son was fine. several hours later we tried contacting pt at the phone number listed on their file but could not reach the pt and could not leave a message


VAERS ID: 1324134 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse reaction noted. Patient under the age of 18. Administration error


VAERS ID: 1324152 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse reaction noted. Patient was under the age of 18.


VAERS ID: 1324210 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Ear discomfort, Electrocardiogram normal, Malaise, Pain in jaw, SARS-CoV-2 test negative, Streptococcus test negative, Throat tightness, Vertigo
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Osteonecrosis (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: tacrolimus 0.1% ointment for eczema, fluocinonide 0.05% ointment for eczema, Olly brand daily multivitamin for teen girls
Current Illness: none
Preexisting Conditions: asthma, eczema
Allergies: none
Diagnostic Lab Data: COVID test and strep test were negative 5/17/21
CDC Split Type:

Write-up: Vaccination was on Saturday, within 10 minutes of the vaccination, my child reported her ears felt like they were popping, she felt dizzy, tight throat and jaw pain. On site nurses gave her apple juice and crackers. She reported feeling unwell, dizzy, light-headed, jaw pain and short of breath the following day, on Sunday. On Monday, we took her to urgent care for same symptoms - unwell, dizzy, light-headed, jaw pain, short of breath. Rapid COVID test and strep test were negative, EKG was normal. Urgent care doctor says it is vertigo.


VAERS ID: 1324258 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Fatigue, Headache, Insomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea, headache, fatigue, violent chills, insomnia, high fever, weakness


VAERS ID: 1324261 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Increased tendency to bruise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spontaneous bruising throughout body. Paresthesia in right leg.


VAERS ID: 1324320 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: nausea, dizziness, vomiting


VAERS ID: 1324513 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Echocardiogram normal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary embolism diagnosed 1-2 weeks after vaccine, now on Eliquis. No right heart strain on echo. Uncertain if vaccine is cause. PE being treated as unprovoked.


VAERS ID: 1324551 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-29
Onset:2021-05-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Colitis, Colonoscopy, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Gastrointestinal haemorrhage, Laboratory test, Ulcer
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lialda (Mesalamine), Entyvio (infusion), Warfarin
Current Illness: Ulcerative Colitis (controlled on medications)
Preexisting Conditions: Ulcerative Colitis
Allergies: Penicillin
Diagnostic Lab Data: May 16th, 2021 Abdominal CT; May 17th, 2021 Colonoscopy; multiple blood draws / labs between May 15th and to date May 17th.
CDC Split Type:

Write-up: I developed a massive GI bleed suddenly 16 days after receiving my second COVID shot. While I am a UC patient, I have had this disease for over 15 years, and this has NEVER happened before. Even when in a flare, and even on blood thinners, I have never had a bleed like this. It required a trip to the ER and a hospital admission for testing and treatment. In the course of my stay, I learned that Ulcerative Colitis patients are now reporting massive GI bleeds after recovering from COVID itself. The doctor couldn''t rule out the possibility that the vaccine caused the bleed. I was admitted May 15th and am expected to be released home to recover on May 18th or 19th. A pelvic/abdominal CT on May 16th showed inflammation in the colon, but a colonoscopy on May 18th showed the evidence of UC was chronic / old disease, while a single significant ulcer was found as the source of the bleed and cauterized. This occurred while the disease was well controlled on medication, literally out of the blue with no other symptoms besides the bleeding.


VAERS ID: 1324988 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205121A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced syncope, fell onto the ground. 911 was called


VAERS ID: 1325412 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had vasovagal event at Vaccine clinic. LOC < 10 seconds, Reported feeling dizzy, nauseous, and lightheaded. Patient was laid down on cot, VSS. Laid for 10 min, sat with legs dangling for 10 minutes. Given juice for sugar boost and water. Patient''s mother present. States he has had episodes like this in the past. Patient is a vegetarian. Denies HA, difficulty breathing, SOB, CP. 1:08pm VS: BP: 84/62 O2: 98% HR: 52 - laying PERRLA, HRR, no vomiting. 1:13pm VS: 90/59, O2:98%, HR:54 Discharged at 1:30pm in stable condition in care of mother. Return/ED precautions given. -


VAERS ID: 1325422 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-05
Onset:2021-05-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient describes red, rash, swelling in her vaccine arm and will be following up with her doctor.


VAERS ID: 1325424 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site swelling, Injection site warmth, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 30MG 1x/day Trazodone 50mg/when needed Motrin Tylenol
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 days after 1st Moderna vaccine redness circled injection site approx 1.25in diameter appeared around 12pm 5/15. Approx 3.5 hours later got sudden, severe headache followed by nausea. Vomited 1x 1 hour later. After resting felt better.. could feel heat radiating in my arm around the injection site without touching it around 6:30pm 5/15/20. Noticed severe swelling around the injection site, approx 5in diameter.


VAERS ID: 1325425 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, allopurinol, amplodipine, Atorvastatin
Current Illness:
Preexisting Conditions: High blood pressure, gout, high cholesterol, overweight
Allergies: Penicillin
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Fever, chills, headache, body ache, fatigue and swelling at injection site. The last symptom has not subsided yet


VAERS ID: 1325440 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Erythema, Limb discomfort, Mobility decreased, Pain, Paraesthesia, Product administered at inappropriate site, Pyrexia, Skin irritation, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Anemia, endometrioma cyst, tachycardia
Allergies: Bananas
Diagnostic Lab Data: None taken yet. I intend to visit the doctor tomorrow.
CDC Split Type:

Write-up: Skin was pinched/bunched upon being administered. Irritation and pain was immediately felt. Swelling, redness, lack of mobility, and pain throughout entire arm has been felt since the injection. At 48 hours out, I developed pain at elbow joint, low-grade fever, and tingling in my pinky finger. I am now 60 hours out, and none of the injection site symptoms have subsided. It appears that it may have been an inadvertent subcutaneous injection, as well as possibly being too high up on my arm.


VAERS ID: 1325776 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sarcoidosis, anemia, high blood pressure, hypertension
Preexisting Conditions: Sarcoidosis
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I took painkillers for pains and Benadryl for itching


VAERS ID: 1325876 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREDNISONE; BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]; CLOZAPINE; VENTOLIN [SALBUTAMOL]
Current Illness: Abstains from alcohol; Cancer; Melanoma; Non-smoker; Penicillin allergy; Pharyngeal polyp (Cancer Survivor x 4: Polyps Vocal Chords); Rheumatism; Sulfonamide allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Pleurisy (Patient was recently Discharged from Hospital for Pleurisy on Tuesday 11-May-2021. Lab work done prior to vaccination during hospital admission at hospital for Treatment of Pleurisy.); Total hysterectomy (Complete Hysterectomy (age 26)); Comments: The patient did not have any abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210529706

Write-up: SUDDEN ONSET DIFFICULTY BREATHING; This spontaneous report received from a patient concerned a 52 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included pleurisy, and complete hysterectomy, and concurrent conditions included penicillin allergy, sulfa allergy, rheumatoid, polyps in throat, non-smoker, non alcohol user, melanoma, and cancer survivor, and other pre-existing medical conditions included the patient did not have any abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 203A21A, expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. Concomitant medications included clozapine, diphenhydramine hydrochloride, prednisone, and salbutamol. On 15-MAY-2021, the subject experienced sudden onset difficulty breathing. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from sudden onset difficulty breathing. This report was non-serious.


VAERS ID: 1326058 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dizziness, Migraine, Muscular weakness, Musculoskeletal stiffness, Oropharyngeal pain, Rhinorrhoea, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: dry cough, runny nose, migraine, dizziness, trouble sleeping, stiffness, weakness in left arm, sore throat,...


VAERS ID: 1326106 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dizziness, Dysphonia, Oropharyngeal pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210530304

Write-up: DIZZINESS; COUGH; SNEEZING; SORE THROAT; SOME HOARSEN; This spontaneous report received from a patient concerned an 83 year old male. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805018, expiry: UNKNOWN) dose was not reported, administered on 07-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced sore throat. On 15-MAY-2021, the subject experienced some hoarsen. On an unspecified date, the subject experienced dizziness, cough, and sneezing. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from sore throat, and the outcome of dizziness, cough, sneezing and some hoarsen was not reported. This report was non-serious.


VAERS ID: 1326200 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-11
Onset:2021-05-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavier than normal menstrual blessing.


VAERS ID: 1326478 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: OVERWEIGHT FHX OF DM FHX OF ISCHEMIC HEART DISEASE PREDIABETES
Allergies: Amoxicillin (hives)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient complained of tongue and jaw feeling "numb and tingly". Vital signs stable. Numbness resolved but throat feels slightly swollen. No wheezing, or difficulty breathing, speaking in full sentences. Doctor onsite consulted. Patient observed for additional 30 minutes. Symptoms resolved. Discharged from clinic with doctor''s approval.


VAERS ID: 1326494 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio normal, Aspartate aminotransferase normal, Basophil percentage decreased, Bilirubin conjugated, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride normal, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood lactate dehydrogenase increased, Blood magnesium, Blood phosphorus normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone increased, Blood urea normal, Bordetella test negative, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chlamydia test negative, Electrocardiogram abnormal, Enterovirus test, Eosinophil percentage decreased, Fatigue, Full blood count, Gamma-glutamyltransferase normal, Globulins decreased, HIV test, Haematocrit normal, Haemoglobin normal, Headache, Hepatitis B antibody negative, Hepatitis C virus test, Human metapneumovirus test, Human rhinovirus test, Immunoglobulin therapy, Influenza A virus test negative, Influenza B virus test, Influenza virus test, Liver function test normal, Lymphocyte percentage, Mean cell haemoglobin concentration, Mean cell haemoglobin normal, Mean cell volume, Mean platelet volume normal, Monocyte percentage, Myalgia, Mycoplasma test negative, N-terminal prohormone brain natriuretic peptide increased, Neutrophil count, Platelet count normal, Pleuritic pain, Protein total normal, Pyrexia, Red blood cell count normal, Red blood cell sedimentation rate increased, Red blood cell sedimentation rate normal, Red cell distribution width normal, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test, SARS-CoV-2 test negative, Thyroxine free normal, Troponin I increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Asthma, remote history.
Allergies: None.
Diagnostic Lab Data: Recent Results (from the past 72 hour(s)) EXT COVID-19 PCR Collection Time: 05/16/21 11:53 AM Result Value Ref Range EXT SARS-CoV-2 RNA (COVID-19) NOT DETECTED NOT DETECTED Troponin I Collection Time: 05/16/21 8:00 PM Result Value Ref Range Troponin I 1.59 (HH) <0.30 ng/mL Respiratory Pathogen PCR Panel Collection Time: 05/16/21 9:32 PM Specimen: Nasopharyngeal Swab Result Value Ref Range Source Nasopharyngeal Adenovirus Not Detected Not Detected Coronavirus 229E Not Detected Not Detected Coronavirus HKU1 Not Detected Not Detected Coronavirus NL63 Not Detected Not Detected Coronavirus OC43 Not Detected Not Detected Human Metapneumovirus Not Detected Not Detected Rhinovirus/Enterovirus Not Detected Not Detected INFLUENZA A PCR Not Detected Not Detected INFLUENZA B PCR Not Detected Not Detected PARAINFLUENZA 1 Not Detected Not Detected PARAINFLUENZA 2 Not Detected Not Detected PARAINFLUENZA 3 Not Detected Not Detected Parainfluenza 4 Not Detected Not Detected Respiratory Syncytial Virus Not Detected Not Detected Bordetella Pertussis Not Detected Not Detected Chlamydophilia Pneumoniae Not Detected Not Detected Mycoplasma Pneumoniae Not Detected Not Detected Bordetella Parapertussis Not Detected Not Detected SARS Coronavirus 2, NAA Not Detected Not Detected CBC auto differential Collection Time: 05/16/21 10:00 PM Result Value Ref Range Comment Specimen clotted. Test not performed. (A) No comment Hepatic function panel Collection Time: 05/16/21 10:00 PM Result Value Ref Range Alkaline Phosphatase 63 52 - 171 U/L AST 38 10 - 55 U/L ALT 21 10 - 55 U/L Total Bilirubin 0.6 0.2 - 1.0 mg/dL Total Protein 7.1 6.0 - 8.0 g/dL Albumin 4.2 3.2 - 4.5 g/dL Bilirubin, Direct <0.2 0 - 0.2 mg/dL Globulin 2.9 1.5 - 3.9 g/dL A/G Ratio 1.4 1.0 - 3.0 Ratio Gamma GT Collection Time: 05/16/21 10:00 PM Result Value Ref Range GGT 16 11 - 50 U/L Magnesium Collection Time: 05/16/21 10:00 PM Result Value Ref Range Magnesium 1.7 1.1 - 2.7 mg/dL Phosphorus Collection Time: 05/16/21 10:00 PM Result Value Ref Range Phosphorus 3.6 2.7 - 4.5 mg/dL C-reactive protein Collection Time: 05/16/21 10:00 PM Result Value Ref Range CRP 4.46 (H) 0 - 0.49 mg/dL Erythrocyte Sediment Rate (ESR) Collection Time: 05/16/21 10:00 PM Result Value Ref Range Sed Rate Specimen clotted. Test not performed. <15 MM/HR proBNP, N-terminal Collection Time: 05/16/21 10:00 PM Result Value Ref Range proBNP, N-terminal 1,433 (H) <125 pg/mL Creatine Kinase, Reflex to CKMB Collection Time: 05/16/21 10:00 PM Result Value Ref Range Total CK 243 (H) 24 - 204 U/L CK total and CKMB Collection Time: 05/16/21 10:00 PM Result Value Ref Range CK-MB 12.3 (H) 0 - 6.4 ng/mL RELATIVE INDEX 5.1 (H) 0 - 3.4 % iSTAT CHEM8+ : Collection Time: 05/16/21 10:03 PM Result Value Ref Range iSTAT TCO2, Venous 30 (H) 20 - 28 mmol/L ISTAT Potassium 4.0 3.5 - 5.5 mmol/L ISTAT Chloride 99 98 - 106 mmol/L ISTAT Creat (with GFR) 1.0 0.5 - 1.3 mg/dL ISTAT BUN 5 5 - 18 mg/dL ISTAT Sodium 140 136 - 145 mmol/L ISTAT Glucose 87 65 - 99 mg/dL ISTAT Ionized Calcium 1.29 1.17 - 1.33 mmol/L POCT COVID-19 and Influenza A/B, BOTH Molecular (LIAT) Collection Time: 05/16/21 10:07 PM Result Value Ref Range Influenza A Not Detected Not Detected Influenza B Not Detected Not Detected SARS Coronavirus 2, NAA Not Detected Not Detected TSH, Highly Sensitive Collection Time: 05/17/21 6:01 AM Result Value Ref Range TSH, High Sensitivity 3.01 0.27 - 4.20 mIU/L T4, free Collection Time: 05/17/21 6:01 AM Result Value Ref Range Free T4 1.10 0.80 - 1.90 ng/dL C-reactive protein Collection Time: 05/17/21 6:01 AM Result Value Ref Range CRP 6.37 (H) 0 - 0.49 mg/dL Erythrocyte Sediment Rate (ESR) Collection Time: 05/17/21 6:01 AM Result Value Ref Range Sed Rate 27 (H) <15 MM/HR Lactate dehydrogenase(Serum) Collection Time: 05/17/21 6:01 AM Result Value Ref Range LDH 200 120 - 260 U/L CBC auto differential Collection Time: 05/17/21 6:01 AM Result Value Ref Range WBC 10.8 4.0 - 11.0 Thou/uL Platelets 270 150 - 450 Thou/uL Hemoglobin 13.6 13.0 - 17.7 g/dL Hematocrit 41.1 39.0 - 54.0 % RBC 4.70 4.50 - 6.20 Mil/uL MCV 87 80 - 100 fL MCH 28.9 25.0 - 35.0 pg MCHC 33.1 30.0 - 36.0 g/dL RDW 12.5 11.5 - 14.5 % MPV 9.5 9.4 - 12.5 fL Segmented Neutrophil 60 % Lymphocyte 23 % Monocyte 12 % Eosinophil 3 % Basophils 2 % Absolute Neutrophil Count, Total 6.5 2.0 - 7.5 Thou/uL Lymphocyte, Absolute 2.5 1.5 - 4.5 Thou/uL Monocyte, Absolute 1.3 0.2 - 1.5 Thou/uL Eosinophil, Absolute 0.3 0.0 - 0.7 Thou/uL Basophil, Absolute 0.2 0.0 - 0.2 Thou/uL Cell Count 100 Normochromic Present Normocytes Present Troponin I Collection Time: 05/17/21 6:01 AM Result Value Ref Range Troponin I 10.43 (HH) <0.30 ng/mL Urinalysis with Reflex to Microscopic Collection Time: 05/17/21 7:30 AM Result Value Ref Range Specimen Clean Catch Color Yellow Clarity Clear Specific Gravity, UA 1.008 1.003 - 1.030 pH, UA 8.0 5.0 - 8.0 Leukocytes, UA Negative Negative Nitrite, UA Negative Negative Protein, UA Negative Negative Glucose, UA 0 0 - 99 mg/dL Ketones, UA Trace (A) Negative Hemoglobin Urine Negative Negative Bilirubin Urine Negative Negative WBC, UA 0 0 - 4 per hpf RBC, UA 0 0 - 4 per hpf Miscellaneous Lab - HHV-6 PCR Collection Time: 05/17/21 11:45 AM Result Value Ref Range NAME Results: Request credited. Referral Lab Performed at facility proBNP, N-terminal Collection Time: 05/17/21 11:45 AM Result Value Ref Range proBNP, N-terminal 1,888 (H) <125 pg/mL Troponin I Collection Time: 05/17/21 11:45 AM Result Value Ref Range Troponin I 14.62 (HH) <0.30 ng/mL Creatine Kinase, Reflex to CKMB Collection Time: 05/17/21 11:45 AM Result Value Ref Range Total CK 746 (HH) 24 - 204 U/L CK total and CKMB Collection Time: 05/17/21 11:45 AM Result Value Ref Range CK-MB 50.3 (H) 0 - 6.4 ng/mL RELATIVE INDEX 6.7 (H) 0 - 3.4 % HIV 1/2 Ag/Ab Rfx Confim Collection Time: 05/17/21 2:45 PM Result Value Ref Range HIV 1/2 Ag/Ab CMIA Nonreactive Nonreactive Hep B Surface Ag, Reflex Confirmation Collection Time: 05/17/21 2:45 PM Result Value Ref Range Hepatitis B Surface Antigen Nonreactive Nonreactive Hepatitis B surface antibody Collection Time: 05/17/21 2:45 PM Result Value Ref Range Hepatitis B, Surface Antibody Reactive (Immune) Reactive (Immune) Hep B Core Antibody Total Reflex IgM Collection Time: 05/17/21 2:45 PM Result Value Ref Range Hepatitis B Core, Total Antibody Nonreactive Nonreactive Hepatitis C antibody Collection Time: 05/17/21 2:45 PM Result Value Ref Range Hepatitis C Ab 0.19 0.00 - 0.79 S/CO ratio Hepatitis C Ab, Interp Nonreactive Nonreactive Troponin I Collection Time: 05/17/21 6:25 PM Result Value Ref Range Troponin I 6.26 (HH) <0.30 ng/mL Troponin I Collection Time: 05/18/21 12:00 AM Result Value Ref Range Troponin I 4.90 (HH) <0.30 ng/mL Troponin I Collection Time: 05/18/21 6:00 AM Result Value Ref Range Troponin I 3.30 (HH) <0.30 ng/mL Troponin I Collection Time: 05/18/21 1:55 PM Result Value Ref Range Troponin I 1.69 (HH) <0.30 ng/mL Echo 5/17/2021 Mildly decreased EF at 52%. Decreased GLS, -16.3%. Cardiac MRI pending, further viral studies pending.
CDC Split Type:

Write-up: Patient is a 17 yo male with no hx asthma who presented to medical center ED as transfer from facility with pleuritic chest pain and fever x1 day. Recent history of second covid vaccine on Friday (5/14). Patient reported associated fatigue, headache and muscle aches late Friday into Saturday (5/15). Sunday patient reported a fever (101 F) and chest pain with deep inspiration. No associated SOB, increased work of breathing or abdominal pain. Was seen initially at urgent care and then referred to facility for "an abnormal EKG." Pertinent findings at facility: troponin 0.31, EKG wnl, rapid covid negative, ESR 9, CK 134, D-dimer <150, WBC 12.4 w/ left shift. Transferred to medical center for further workup. While in medical center ED, troponin 1.59. EKG rSR'' leads V1-V3 w/o ST segment elevation. MISC tier 1 studies drawn. Cardiology consulted - admit for observation, myocarditis infectious workup, echocardiogram and During his time in the ED, patient continued to have pain with deep inspiration as well as when he had to yawn. He other wise felt fine. Vital signs normal throughout out time in ED. His troponin continued to rise, with max of 14, so decision was made to start IVIG and steroids. His troponin fell over the next day. He remained stable from a clinical standpoint, and symptoms had resolved by the morning of 5/18. At time of filing, patient is still hospitalized at medical center, with further labs and imaging pending.


VAERS ID: 1326522 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-04-30
Onset:2021-05-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram head, Concussion, Electrocardiogram, Full blood count, Head injury, Loss of consciousness, Metabolic function test
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamins Vit.D 2000 units BkackbElderberry, Vit. C and Zinc
Current Illness: None, healthy
Preexisting Conditions: None
Allergies: Benzoyl Peroxide( topical)
Diagnostic Lab Data: CBC CMP EKG Blood sugar check CT scan of head
CDC Split Type:

Write-up: 5/15/2021 passed out while taking shower, and passed out 2nd time outside bathroom ( witnessed) , hit head on side of door ,was seen in ER for head injury/ concussion Labs , EKG, Blood sugar , and Head CT scan done - normal results , referred to concussion doctor within 3-5 days


VAERS ID: 1326525 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Nausea, Polymerase chain reaction
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE
Current Illness: N/A
Preexisting Conditions:
Allergies: PCN
Diagnostic Lab Data: PCR
CDC Split Type:

Write-up: PATIENT EXPERIENCING HEADACHES, CHILLS, NAUSEA, DIARRHEA FOR 4 DAYS NOW


VAERS ID: 1326528 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Mobility decreased, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: April 11th, 2021
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started feeling nausea, after 3 hours fever rose to 103.0F. Body aches, severe chills and fever. Could not stand up and walk and had to use urinal. Took Tylenol every 4 hours. Fever broke after eight hours. Next day, low grade fever, weakness and horrific pain at injection site. Could not use or raise arm given the injection. Third day and out of bed, feeling better.


VAERS ID: 1326565 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I gave a 21yo male a Janssen vaccine approximately 508p on 5/15. Vaccination was routine and the patient walked to the observation chair. Around 520p, an acquaintance of the patient came up asking for a vomit bag. I went out to the observation chair with a small trash can and paper bag and at 522p the patient stated he felt dizzy and vomited. My technician stayed with the patient, and I went to the pharmacy to grab paper towels, a new mask, and a bottle of water. I came back and asked the patient how he was feeling (524p). He said that he felt much better after vomiting. I asked if he wanted a cold pack or water, and he took the bottle of water and denied the cold pack. I asked him to continue to stay for observation. At 537p, I went out to see how the patient was feeling. He stated he was feeling better and was no longer dizzy. At 538p (30 minutes after vaccination) the patient stated he felt comfortable to leave and continue shopping in the store with his acquaintance.


VAERS ID: 1326576 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Gastrointestinal haemorrhage, Hyporesponsive to stimuli, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Severe swelling to the legs, obesity, tachycardia, irregular heart rate
Preexisting Conditions: Severe swelling to the legs, obesity, tachycardia, irregular heart rate, client had not sought any medical care for 15 years.
Allergies: NKDA
Diagnostic Lab Data: I do not have this information.
CDC Split Type:

Write-up: Client vaccinated in their own home through partnership with local EMS. Day of vaccination, the EMS noted tachycardia and severe swelling of the lower extremities, but client was alert and oriented. Appox 24 hours later, client was slow to respond and her coloring was "gray." Ambulance called and client hospitalized. Client found to have GI bleed of unknown cause. Providers involved in her care do not believe it is related to the vaccine.


VAERS ID: 1326604 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-11
Onset:2021-05-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis, Pain in extremity, Pharyngeal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 10mg Tab (Stopped taking Statins after first nose bleeding adverse event on Saturday 15th May 2021, 3 days after the Pfizer Covid Vaccination 2nd shot).
Current Illness: None
Preexisting Conditions: Managing Cholesterol with Statin medication
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving my second Pfizer Covid Vaccine shot last week (11-May-2021), I suffered nose bleed (left nose) on Saturday morning (15-May-2021) and didn''t think much about it. This continued Sunday (16-May-2021), Monday (17-May-2021) and also today Tuesday afternoon (18-May-2021). The amount of bleeding increased significantly through to today and the last 3 times I noticed bleeding in the back of my throat. And I initially tried applying pressure to the nose section and now it is taking more than 15 - 20 minutes for this to stop. I am very concerned and will be contacting my Primary physician as soon as possible. Actually I had 2 other instances of nose bleeds after the first shot (14-Apr-2021) but I brushed it aside thinking it was due to cold weather or irritation from picking. I have not had nose bleeds prior to this event. I did not have any fever or chills from both vaccinations other than the sore left arm so this was not weighing my mind much. However, now I am concerned at the adverse events following Pfizer Covid vaccination shots.


VAERS ID: 1326681 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Hypoaesthesia oral, Peripheral swelling, Rash, Skin tightness, Skin warm, Swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Spiralactone, Mirena, Atorvastatin, Proair, and Wixela
Current Illness: None
Preexisting Conditions: Asthmatic
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in the left arm, rash, bruising, skin felt tight and hot. Swelling progressed up towards the left side of my neck and the left side of my face. Left side of my face swelled and developed the same rash, skin tightening and hot to the touch. Also, the upper lip is numb (left side).


VAERS ID: 1326690 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site inflammation, Injection site mass, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received my 2nd dose of Moderna Covid-19 vaccine on 5/14/21. 12 hours later I developed a hard lump rash over the injection site. The rash has progressed severely since 5/15/21 (today is 5/18/21). Rash is red, swollen/inflamed, hot to the touch, painful and has spread from the size of a golf ball to almost covering my entire upper right arm in the course of 4 days. It continues to spread and grow each day, although it is not as red. I''ve tried Benadryl cream (at the advisement of the pharmacist who administered the vaccine), ice packs, cool compress, Motrin and aloe Vera. The rash has not responded to any treatment listed above.


VAERS ID: 1326695 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient misrepresented age when making vaccine appointment and when asked verbally regarding age


VAERS ID: 1326700 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient misrepresented age when making vaccine appointment and when asked verbally


VAERS ID: 1326718 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site cellulitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Two weeks after injection patient developed cellulitis at the injection site


VAERS ID: 1326721 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB, Blood creatine phosphokinase decreased, Blood creatine phosphokinase increased, C-reactive protein increased, Chest pain, Chills, Echocardiogram abnormal, Electrocardiogram ST-T change, Electrocardiogram normal, Fatigue, Intensive care, Myocarditis, Pain, Pyrexia, Red blood cell sedimentation rate normal, Respiratory viral panel, SARS-CoV-2 antibody test positive, Troponin increased, Ventricular dyskinesia, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Afrin nasal spray 2 pumps to each nostril every other day.
Current Illness: Congestion and runny nose. Denies fevers, nausea, vomiting, diarrhea, rashes, sick contacts, coughing, wheezing.
Preexisting Conditions: None.
Allergies: No food allergies, no medication allergies. (+) pollen allergies.
Diagnostic Lab Data: Patient is a 17-year-old male with no significant past medical history who presents with 1 day of sudden onset sharp chest pain, found to have diffuse ST elevation on EKG as well as elevated troponin consistent with acute myopericarditis. Must consider whether presentation is related to patient having received his 2nd COVID-19 vaccine 2 days prior to presentation. COVID-19 spike protein antibodies are positive but no evidence of prior infection. However, will also evaluate possible viral causes for the myopericardial inflammation. Patient is currently hemodynamically stable but admitted to the PICU for telemetry due to risk for dysrythmia given myocardial inflammation. Working dx of myopericarditis secondary to possible COVID vaccine. #CV - Continue indomethacin 50mg TID - EKG from this AM: NSR with ST/T changes - ECHO: mild left ventricular apical dyskinesis (left ventricular systolic function borderline low with decreased wall excursion at apex with good RV systolic function and no significant pericardial effusion). -- Repeat ECHO today: globally borderline mildly depressed systolic function with mild hypokinesis as the ventricular apex. No significant pericardial effusion. Stable findings from ECHO 5/16/21. - Troponin elevated to 1.63 $g 1.72 $g 1.75 $g 2.52 - CKMB: 109.1 (0-6.3) -- Ratio 14.4% (0-3.9%) - CPK: 759 - Cardio on consult -- recommends daily trending of labs - Qday ECGs ++ when pt clinically is symptomatic - Monitor for signs for clinical worsening #ID - COVID-19 spike protein Ab: (+), COVID-19 Nucleocapsid Ab: (-) - Obtain workup for viral myocarditis (CMV, EBV, adenovirus, enterovirus, coxsackievirus, adenovirus, Parvo B19) -- F/u results - RVP: negative - ESR 14 $g 15 - CRP 8.12 $g 6.54 - ID on consult -- recommends the MISC lab workup for possible MISC vs. adverse reaction to vaccine (CBC, CMP, BNP, COVID PCR, COVID Ab, ESR, CRP, BCx, UA, UCx, fibrinogen, PT/PTT, D-dimer, Ferritin, Procalcitonin, LDH, VBG (iCal, lactate), troponin, CPK). #FEN/GI - Regular diet - Pepcid 20mg BID
CDC Split Type:

Write-up: 5/14/21 - day 1 after vaccine dose #2 - had fevers, body aches, chills, fatigue. 5/15/21 - day 2 after vaccine dose #2 - began to have chest pain that started out at 5/10 and then became constant and persistent sharp, 10/10 chest pain that was worse with lying back and improved with sitting up and leaning forward. Pt went to Urgent Care, had ECG done and demonstrated ST wave changes where he was brought to ED and ECG confirmed ST/T wave changes and Troponin T was elevated to 1.62 - thus with these findings and the chest pain that was consistent with pericarditis - diagnosis of myopericarditis was made.


VAERS ID: 1326735 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site mass, Injection site pain, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate, folic acid, bupropion, bisoprolol,
Current Illness:
Preexisting Conditions: Psoriatic arthritis, high blood pressure, obesity
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Half dollar size hard lump at injection site. Painful and itchy appeared 2 days after injection.


VAERS ID: 1326736 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood test, Chest pain, Chills, Dyspnoea, Electrocardiogram, Fatigue, Pain, Pleurisy, Pneumonitis, X-ray
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: EKG, X-Ray, Blood tests
CDC Split Type:

Write-up: Difficulty breathing, sharp chest pain when breathing that radiates to my back. Chills and extreme fatigue. Diagnosed and receiving treatment for Pleurisy or inflammation of the lungs at the ER two days after receiving the vaccine.


VAERS ID: 1326757 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-08
Onset:2021-05-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan/ hctz amlodipine triam/HCTZ
Current Illness: none
Preexisting Conditions: HTN, impaired fasting glucose
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: rash that started out on same arm of vaccine 1 wk post 2nd covid vaccine that has spread to rest of body. presents like allergic dermatitis. other causes for allergic dermatitis were ruled out


VAERS ID: 1326767 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Feeling hot, White coat hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypothyroid; Recently changed supplements and no recent TSH.
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: About 15 minutes after immunization during observation, patient complained of feeling hot all over and somewhat lightheaded. denied chest or other pain, shortness of breath, nausea . initial blood pressure was 210/ $g100. Patient assisted to a cot to lay flat. further hx: no prior vaccination problems, but reports only few vaccines in her lifetime. Reports recent change in thyroid supplement few weeks prior . No TSH level since change. Has not been checking BP, but has cuff at home. No known hx hypertension or cardiac disease. hx "white coat HTN" remotely. repeated BP every 5 minutes; 184/92, 72. 172/84, 78. By 30 minutes after vaccine, patient was feeling normal. Was asymptomatic sitting up and then standing . She was discharged with instructions to continue checking her blood pressure at home and if persistently $g 140/90, she is to f/u with her medical provider. It was also suggested that she speak with her provider about TSH check 6 weeks after starting her new supplement dose.


VAERS ID: 1326978 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, chills, Fatigue, Shakiness


VAERS ID: 1326989 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Heart rate increased, Injection site pain, Night sweats, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastin, vascepa
Current Illness: minor head cold 2 weeks prior to vaccination
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: That evening I had chills followed by night sweats. My heart beat was racing over 130 beats per minute for over 8 hours. Headache, 104 degree fever, severe fatigue, pain at injection site, cough developed


VAERS ID: 1327010 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Loss of consciousness, Nausea, SARS-CoV-2 test, Ultrasound scan, Vomiting, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT- normal blood work- unknown X-Ray- normal Cardiac US-normal Covid Test- unknown
CDC Split Type:

Write-up: On 5/15/21 pt was in a drive through vax site. He says immediately after he got the vax he was trying to drive away from the vax site but he has to pull over since he was passing out. He came to so put his car in park and then passed out again. He said he was nauseated, dizzy, and lightheaded. He kept going in and out. He blew the horn and got someone''s attention. EMTs loaded him into an ambulance then he started vomiting. They took him to the Medical Center. They did multiple tests. He was admitted for further testing which had normal results. Pt was discharged after about 28 hours. Pt says he could stand up about 4 hrs after inj but the symptoms lasted about 18 hours total.


VAERS ID: 1327185 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient Fainted and we called EMS. Patient was fine after resting for a few minutes


VAERS ID: 1327191 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-05-15
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fall/syncope


VAERS ID: 1327199 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: info not known
Current Illness: info not known
Preexisting Conditions: no known health conditions
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after vaccine, patient felt very dizzy, and pale. she was sitting in chair. she was responsive and talking but patient''s mother wanted us to call 911/. Paramedics took her vital signs and she was good.


VAERS ID: 1327200 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient vomited and fainted. We already had EMS here for his sibling. He was also fine after resting and calming down.


VAERS ID: 1327227 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Migraine, Neck pain, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase nasal spray Fexofenadine 180mg PO Albuterol nebulizer Symbicort inhaler Sumatriptan 100 mg PO was taken after the vaccine was given and the HA started.
Current Illness: Denies
Preexisting Conditions: Asthma and environmental allergies, Migraines
Allergies: Penicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fatigue, HA and migraine, neck pain, body aches, diarrhea that have lasted 4 days. Pt has taken Tylenol, Meloxicam, and Sumatriptan with mild improvement after medication but HA returns later. Diarrhea has improved. No improvement in body aches or fatigue


VAERS ID: 1327442 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rectal Bleeding


VAERS ID: 1327466 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-05-15
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030MZ0A / 2 UN / SC

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Confusional state, Decompressive craniectomy, Headache, Subdural haematoma evacuation, Subdural haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan, metoprolol, protonix, disulfram
Current Illness: none
Preexisting Conditions: hypertension, alcohol use disorder
Allergies: NKDA
Diagnostic Lab Data: head CT, surgical decompression via mini-crani
CDC Split Type:

Write-up: subdural hemorrhage: presented with confusion and headache. Required evacuation


VAERS ID: 1327477 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Ultrasound showed posterior tibial vein occlusive clot
CDC Split Type:

Write-up: Patient had vaccine on the 12th. Leg pain three days later. Diagnosed with DVT six days later. No risk factors for DVT. Unknown lot number for vaccine. Not done at my faciluty


VAERS ID: 1327523 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client c/o light headed feeling. She gets the same feeling when she rides on the trains. Vitals taken by paramedics and it was normal.


VAERS ID: 1327539 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Latuda loestrin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Moderna vaccine as a 16 yr old.


VAERS ID: 1327568 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient said 4 years prior he received a Tdap shot and "passed out for several minutes" but he asked the doctor about it at the
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: No Known Drug Allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sequence of Events re Incident * Patient made his appointment via on- line scheduler * Patient came in, filled out his paperwork, made no mention of previous vaccine issue on paperwork * I performed the usual screening of patient, and when I asked him about any previous reactions to immunizations he stated that he had an ?issue with a TdaP shot 4 years ago and passed out in doctor?s office for several minutes.? He stated the MD told him that ?he had several other issues with the shot so the MD said it was a ?bad batch??. * I made sure that the patient was comfortable about getting the Covid shot and he agreed that he was fine to get it. At that time the patient did not seem overly nervous about receiving the shot. * I administered the shot to the patient and he went directly to the seats next to the pharmacy. I asked him to stay there because he had a past issue with another vaccine. * Approximately 2-3 minutes later, the patient came back, looked troubled and said he didn?t feel well and was feeling the same way as the other shot. I brought him back into the pharmacy immunization room, sat him down and put his head between his knees. I did a quick check on him to be sure he was breathing OK and that there was no apparent allergic reaction. * After a minute I brought his head back up and put patient into regular seated position. At no point did he completely lose consciousness or faint. I asked him at that point if he wanted me to call an ambulance or a family member and he declined. He sat there in the chair for approximately 15 minutes- part of the time his head was in his hands, part of the time looking at his phone. He asked for a glass of water and I got him one (he had completely drank it by the time he left). I kept checking on him and it seemed like every time he saw me check on him he put down his phone and put his head in his hands again. He could have been embarrassed by the situation, unsure though. I tried to make him as comfortable as possible. * After 15-20 minutes I asked him if he wanted me to call someone and he said at that point he wasn?t sure he wanted to drive home so he would call his mother to pick him up, which he did. * I sat down with him for a couple of minutes and explained that this was called a vasovagal response and was quite common (I even empathized with him by explaining that I have the same response when I get blood drawn at the doctor?s office). He seemed to feel a little better after I explained it to him. * His mother came in 15 minutes later and I brought her back as well. She explained the same thing happened at the MD office 4 years ago and that it was the Meningitis shot, not Tdap. I explained to them going forward that it would probably be best to get his immunizations at the doctor?s office so that he could lay down after the shot and they agreed. * He and his mother then walked out of the immunization room and left the building. He left under his own power and without assistance from his mother. I gave him a business card and asked him to call me on Sunday to let me know that he was feeling ok.


VAERS ID: 1327658 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Chills, Echocardiogram, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pain, Pleuritic pain, Pyrexia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: See above. Cardiology consult 5/17/2021, Infectious Diseases consult 5/18/2021
CDC Split Type:

Write-up: He had Moderna vaccine #2 on 5/13/2021. The day after the vaccination he had fevers and chills. Two days after his vaccination (5/15/2021) he developed mild midsternal chest pain. This worsened and on 5/16/2021 he felt like someone was sitting on his chest. This pain was worse with deep breaths and radiated to his shoulders. He sought care at an urgent care clinic where EKG unexpectedly showed diffuse ST elevations. He was referred to the ED where he had an elevated troponin and there was concern for myocarditis. TTE done showed a normal ejection fraction and normal heart valves. He denies recent illnesses. He denies recent sore throats or skin infections. He works in the hospitality industry but denies known recent COVID-19 infection. Since admission he was seen by cardiology and was started on colchicine, indomethacin, and protonix. Telemetry has been reassuring. He reports feeling much better.


VAERS ID: 1327763 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1345, EMT found patient on ground. Patient''s mother stated patient fainted and fell face first onto ground from chair. Patient was alert and oriented to person, place, time and situation. Patient stated she felt dizzy before she fainted. Patient reported no history of fainting, eating breakfast, and no chronic conditions. At 1350, patient vitals were blood pressure 124/80 mmHg, pulse 65 beats/minute, and SpO2 95%. At 1349, 911 activated . At 1353, paramedics arrived and assumed care. Patient''s mother signed an Against Medical Advice form. Paramedics left scene at 1407. Lead RN educated patient and patient''s mother on following up with primary care provider, signing up on v-safe, and signs/symptoms of when to seek emergency care. Patient left observation area with mother at 1409.


VAERS ID: 1328287 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Evaluated via Telehealth.
CDC Split Type:

Write-up: Started having symptoms of fever and bodywide muscle aches. Fever reached 102 F. Sought care at medical clinic.


VAERS ID: 1328759 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness:
Preexisting Conditions: GERD anxiety scoliosis
Allergies: gramineae pollens
Diagnostic Lab Data: MRI cardiac morph with and without IV contrast Result Date: 5/17/2021 1. There is MRI evidence to support very mild regional myopericarditis as detailed above. 2. No significant pericardial effusion. 3. Biventricular ejection fractions are within normal limits. 4. Biventricular end diastolic volumes are mildly depressed. Exam images have been permanently archived. Troponin peak measurement 6.42 5/16/2021.
CDC Split Type:

Write-up: Myopericarditis as demonstrated on cardiac MRI.


VAERS ID: 1328959 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cold sweat, Fatigue, Feeling abnormal, Musculoskeletal pain, Pain, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Just general tiredness
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Zero arm pain until around 8PM. Then came on and intensified for next two hours. Became very tired. Went to bed at 10PM. Woke up at 12;30AM with a 101 degree fever and intense pain in lower back/upper buttocks. Fever/pain persisted and worsened throughout the night. Aches spread to other areas of my body but still centralized to back/buttocks. Headache introduced in the AM. Fever bounced all day between 102 and 104.2 degrees all day until about 8:30PM on Sunday. Tried ibuprofen to manage pain and temperature but had minimal effect. General tingly and buzzy feel after 8:30PM and into Monday. Headeache reappeared on Monday evening with cold sweats. Strange calf ache in right leg Monday night into Tuesday AM that consistently woke me up. Tried massage, stretching, to no avail. Tuesday AM most everything dissipated with just a bit of fogginess throughout Tuesday (though less than Monday).


VAERS ID: 1328993 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: citalopram
Current Illness: None
Preexisting Conditions: None
Allergies: fluconazole
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, swelling, warm to touch at the injection site that increased over 3 days - Swelling, redness decreased on Day 4 Treated with oral anti-histamine, ibuprofen, and cold compresses on D1 and D2


VAERS ID: 1329108 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Smoker (less than a pack per day)
Preexisting Conditions: Comments: Patient had no known drug allergies and no known drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210530321

Write-up: HEADACHE; This spontaneous report received from a patient concerned a 51 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcoholic, and smoker, and other pre-existing medical conditions included patient had no known drug allergies and no known drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609 expiry: 09-JUN-2021) dose was not reported, administered on 14-MAY-2021 16:30 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache. This report was non-serious.


VAERS ID: 1329122 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Muscle spasms
SMQs:, Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NAPROXEN SODIUM
Current Illness: Non-smoker; Seasonal allergy (Taking allergy medication); Social alcohol drinker (2 beers a month)
Preexisting Conditions: Medical History/Concurrent Conditions: Ankle injury (2 months ago); Leg cramps; Comments: No drug abuse or illicit drug usage. history of taking birth control medication 40 years ago but she stopped it since then due to severe leg cramps.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210530911

Write-up: LEG CRAMPS; TIREDNESS; This spontaneous report received from a patient concerned a 62 year old female. The patient''s weight was 140 pounds, and height was 153 centimeters. The patient''s past medical history included left ankle injury, and leg cramps, and concurrent conditions included seasonal allergy, social alcohol drinker, and non-smoker, and other pre-existing medical conditions included no drug abuse or illicit drug usage. history of taking birth control medication 40 years ago but she stopped it since then due to severe leg cramps. The patient experienced drug allergy when treated with morphine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, and batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. Concomitant medications included naproxen sodium. On 15-MAY-2021, the subject experienced leg cramps. On 15-MAY-2021, the subject experienced tiredness. The action taken with covid-19 vaccine a was not applicable. The patient recovered from leg cramps on 15-MAY-2021, and had not recovered from tiredness. This report was non-serious.


VAERS ID: 1329158 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532425

Write-up: DIARRHEA; EXTREME FATIGUE; MUSCLE ACHE; This spontaneous report received from a patient concerned a 47 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A and expiry: 31-JUL-2021) dose was not reported, administered on 13-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced diarrhea. On 15-MAY-2021, the subject experienced extreme fatigue. On 15-MAY-2021, the subject experienced muscle ache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from diarrhea, extreme fatigue, and muscle ache. This report was non-serious.


VAERS ID: 1329162 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SEROQUEL; LOXAPINE; WELLBUTRIN
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Blood transfusion; Cardiac operation (three years ago); Postpartum bleeding; Uterine dilation and curettage; Comments: The patient was not pregnant at the time of vaccination. The patient had no known allergies. The patient had no history of drug abuse or illicit drug use. Medical history include hormone pill ,thyroid pill.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532761

Write-up: SWOLLEN ANKLES/BOTH THE LEGS; PAIN IN ANKLES; This spontaneous report received from a patient concerned a 47 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included bleeding after first baby, blood transfusion, dnc after a month for second baby, and heart surgery to get water out of heart, and concurrent conditions included no alcohol use, and non smoker, and other pre-existing medical conditions included the patient was not pregnant at the time of vaccination. the patient had no known allergies. the patient had no history of drug abuse or illicit drug use. medical history include hormone pill ,thyroid pill. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 11-MAY-2021 for prophylactic vaccination. Concomitant medications included bupropion hydrochloride, loxapine, and quetiapine fumarate. On 15-MAY-2021, the subject experienced swollen ankles/both the legs. On 15-MAY-2021, the subject experienced pain in ankles. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from swollen ankles/both the legs, and pain in ankles. This report was non-serious.


VAERS ID: 1329673 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Application site induration, Application site rash, Fatigue, Headache, Pain in extremity, SARS-CoV-2 test positive
SMQs:, Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known medical history and no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 202012; Test Name: COVID-19 virus test positive; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210533639

Write-up: BUMP IN THE LEFT ARM; HARD BUMP IN LEFT ARM; SORE ARM; HEADACHE; TIREDNESS; This spontaneous report received from a patient concerned a 44 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known medical history and no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On DEC-2020, Laboratory data included: COVID-19 virus test positive (NR: not provided) Positive. On 15-MAY-2021, the subject experienced sore arm. On 15-MAY-2021, the subject experienced headache. On 15-MAY-2021, the subject experienced tiredness. On 17-MAY-2021, the subject experienced bump in the left arm. On 17-MAY-2021, the subject experienced hard bump in left arm. The action taken with covid-19 vaccine was not applicable. The patient recovered from headache, and tiredness, and had not recovered from bump in the left arm, sore arm, and hard bump in left arm. This report was non-serious.


VAERS ID: 1329679 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Hot flush, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxycondin, ondesatron, metamucil
Current Illness: Neuroendocrine carcinoma
Preexisting Conditions: N/A
Allergies: Y-80 ingredient in J&J shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe cough, runny nose, hot flashes, pain in chest


VAERS ID: 1329911 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Gait disturbance, Groin pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Joint Pain-Severe, Additional Details: Pt presented to pharmacy on 5/18 (5 days after immunization, 3 days after symptoms began) complaining of severe, persistent pain in R hip ("can hardly walk"). Also states that he had chest pain, groin pain that has since subsided. Pt wanted to see NP but was unable to, does not have a regular healthcare provider.


VAERS ID: 1329948 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 022B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Lisinopril Hydrochlorothiazide
Current Illness: n/a
Preexisting Conditions: Hypertension
Allergies: Celecoxib Dapsone Loop diuretics Sulfonamides / Sulfa Saccharin Tetracyclines Thiazide-type diuretics Tigecycline Triptans
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5:15pm: Light headedness and soreness along right forearm down to right hand. 5:30pm: BP 184/110. Pt sitting on ground. Alert and talking/laughing/normal breathing. Was told by EMS to not give pt water/food in case of exacerbation. 5:40pm: EMS arrived 6:30pm: Pt discharged, reported BP down to 140/??


VAERS ID: 1329999 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Inflammation, Muscle tightness, Musculoskeletal stiffness, Pain, Tendonitis
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: testesterone, tadalafil, anastrozole fish oil, curcumin, zinc, vitamin, b6, d3, k, c
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe joint pain. Mainly in elbows/forearms, shoulders, finger joints. Stiffness. Also tendonitis symptoms. A pulsating inflammation feeling while being stiff to move with pain. Shoulders tight. I work out heavily and always have some joint issues, but this made it impossible to workout. Too much pain and concern.


VAERS ID: 1330046 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1330049 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-14
Onset:2021-05-15
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: COVID-19 test on 5/15/21
CDC Split Type:

Write-up: Patient received Janssen vaccine on 3/14/21 according to her daughter. Patient is staying with daughter and family where some members tested positive. Patient herself tested positive on 5/15/21, she is completely asymptomatic.


VAERS ID: 1330052 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1330063 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1330070 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-29
Onset:2021-05-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, empagliflozin, insulin glargine, lisinopril, metformin, multivitamin, silver sulfadiazine cream, vitamin D.
Current Illness:
Preexisting Conditions: HTN, diabetic reoccuring foot wounds, DM 2, hyperglycemia, morbid obesity.
Allergies: No known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received COVID-19 J&J vaccination on 4/29/2021. Pt began having symptoms of COVID around 5/8/2021, worsening to the point of needing hospitalization on 5/15/2021. Diagnosed with COVID pneumonia. Hospitalized for 3 days, symptoms improved enough to discharge.


VAERS ID: 1330142 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-19
Onset:2021-05-15
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Naproxen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Shingles


VAERS ID: 1330211 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER - BIONTE / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lingering headache Called doctor - no appointment needed at this time


VAERS ID: 1330412 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: eosinophilic esophagitis
Allergies: Seafood
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 114, patient reported feeling light headed to EMT. EMT assessed patient vitals: blood pressure (unable to obtain blood pressure), SpO2 94%, and pulse 54 beats/minute. Patient given water and rested head on mother''s shoulder. Patient reported no difficulty breathing/itchiness/hives/rashes. Patient reported history of eosinophilic esophagitis. Patient reassessed at 1120. Patient vitals were blood pressure (unable to obtain), SpO2 96% and pulse 96 beats/minute. Patient reassessed at 1140. Patient vitals were blood pressure 96/80 mmHg, SpO2 100% and pulse 90 beats/minute. Patient stated she felt a lot better. Lead nurse educated patient on following up with primary care provider, signing up on v-safe, and signs/symptoms of when to seek emergency care.


VAERS ID: 1330468 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-08
Onset:2021-05-15
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Irritability, Muscle spasms, Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE KNOWN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This patient is 77 years old, and had a menstrual cycle that began 5/15/2021 and lasted until 5/18/2021. She has not menstruated in over 30 years. She experienced cramps, low back pain, and irritability.


VAERS ID: 1330509 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone newly started 5/14/21 for acne
Current Illness:
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data: Electrolytes done 5/18 normal.
CDC Split Type:

Write-up: New onset vertigo started 5/15 and continued through her office visit on 5/18. Had covid vaccine two days prior two symptom onset and started spironolactone (new medication for her prescribed by dermatologist for acne) one day prior to symptom onset.


VAERS ID: 1330532 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anion gap normal, Blood calcium normal, Blood chloride normal, Blood cholesterol increased, Blood creatine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone decreased, Blood triglycerides increased, Blood urea normal, Brain natriuretic peptide increased, Carbon dioxide normal, Chest discomfort, Dyspnoea, Electrocardiogram abnormal, Glomerular filtration rate normal, Glycosylated haemoglobin normal, High density lipoprotein decreased, Low density lipoprotein increased, Nausea, Pain, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No OTC medications. Lisinopril 10mg QD, gabapentin 600mg TID, lumigan eye drops.
Current Illness: N/A
Preexisting Conditions: Hypertension. Hypercholesterolemia (2008). Family history of premature coronary artery disease.
Allergies: Augmentin and penicillin.
Diagnostic Lab Data: Troponin- 0.015 @0115 5/15, 0.747 @0601 5/15, 0.963 @0545 5/16 BP on admission: 111/58 @0300 5/15 Pulse 80, 02 saturation 100% The following labs were collected at 0545 on 5/16/21: Cholesterol panel- Total cholesterol-233, Triglycerides 182, HDL 42, LDL 155 BMP- Na 137, K 4.6, Cl 100, Co2 29, glucose 107, BUN 13, Cr 1.01, Ca 9.6, Anion gap 8, eGFR $g60 A1c 5.2% ProBNP 330 TSH 0.918
CDC Split Type:

Write-up: Information below was sourced from the patient record in the hospital EHR system: Patient presented to ED with PMH of HTN and family history of premature CAD who presented with 2 hours duration of substernal chest discomfort. He had been in his usual state of health prior to this evening. He received the COVID Vaccine on 5/12/21. He went out with his wife for dinner and then upon return, started to have some substernal chest discomfort radiating down his arm. This is associated with some SOB and nausea. No vomiting, no diaphoresis. The pain continued for about 2 hours and then he decided to come to the ED. The EKG was consistent with inferolateral wall MI. States that he has been very active without exertional chest pain or dyspnea. He does have a history of HTN and is currently on lisinopril for this. No known history of hypercholesterolemia. Denies any diabetes. No smoking history. No history of PVD. His mother did have a bypass in her early 60s. At age 37, he did have a catherization following an episode of substernal chest discomfort. The patient states this catherization did not show any abnormalities. Following this, the patient proceeded for PCI stenting with a DES for an occluded OM2 . Patient received Aspirin, Brilinta, Atorvastatin, Metoprolol, and Heparin prior to PCI stenting. Cardiology note confirms acute inferolateral STEMI due to occluded OM@, successfully opened and stented acutely.


VAERS ID: 1330687 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Miosis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Over the Counter Vitamins 1/qd Singulair 1/qd Claritin 1/qd Effexor 1/qd
Current Illness: NO
Preexisting Conditions: NO
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after my Covid vaccine May 15, 2021, the pupil in my right eye was constricted compare to my left pupil which was fully dilated in direct light. The day after that, May 16, 2021, my pupil was back to normal.


VAERS ID: 1330871 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiomyopathy, Echocardiogram, Electrocardiogram ST segment elevation, Palpitations, Pericarditis, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiomyopathy (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: "The patient presented with symptoms of pericarditis and palpitations. Evaluation revealed elevated troponin levels consistent with myocardial injury, ST elevation on ECG (consistent with pericardial inflammation) and short episodes of non-sustained ventricular tachycardia that were not hemodynamically significant. Echocardiography revealed normal anatomy and normal ventricular / valvular function with no pericardial effusion. He was observed in hospital on telemetry for 24 hours and transitioned to outpatient care with exercise restrictions as well as oral non-steroidal anti-inflammatory and colchicine therapy. Clinical diagnosis was peri-/myocarditis without ventricular dysfunction."


VAERS ID: 1331020 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG: diffuse ST elevation Troponin 22.813 (Reference range: 0.006 - 0.060 NG/ML ) 5/16/21 0857 Troponin 29.2 (Reference range: 0.006 - 0.060 NG/ML ) 5/16/21 1302 Troponin 7.528 (Reference range: 0.006 - 0.060 NG/ML ) 5/18/21 0731 Echo: normal 5/16/21
CDC Split Type:

Write-up: Patient developed severe chest pain and was found to have myopericarditis. This occurred 3 days after receiving his 2nd Pfizer covid vaccine. Prior to this event, he was in his usual state of health and denied any viral prodrome or illness. In the hospital, he received NSAIDs and supportive care with significantly clinical improvement. He was discharged with cardiology follow up.


VAERS ID: 1331208 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Blepharospasm, Hot flush, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: In her eyes, patient felt tingling and fluttering; we could not see her eyes moving at all. She also felt tingling in both arms, both hands, her face, and torso; she also had a lot of pain in her back. She felt that her face was hot but to the touch it was not. After about 20 minutes of these sensations her fingers cramped in gnarled positions that she was unable to straighten. Her right hand fingers was more rigid than her left. This lasted about 30 minutes and then she was slowly able to straighten her fingers. By the time she went to bed, around 10 pm, she felt basically back to normal.


VAERS ID: 1331490 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN MODERNA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA or food allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Erythema swelling and tenderness to the L upper arm at the area of the injection site.


VAERS ID: 1331785 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Right after the shot, pt feels dizzy and went passing out for a few seconds, turn pale, then came back within seconds, start sweating and was laid on floor. Paramedics came and checked on her, she is alert and responding to questions. She went home with Mom after being checked by paramedics.


VAERS ID: 1331833 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest pain, Dyspnoea, Electrocardiogram, Malaise
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood tests for blood clots... EKG
CDC Split Type:

Write-up: I felt really sick the following day! I had COVID-19 prior to this so it felt like that again... 48 hours after I had chest pain and shortness of breath! I went to the hospital and my blood pressure was 166 over 99... blood tests came back ok for now


VAERS ID: 1332404 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Eructation, Laboratory test normal, Retching, Tryptase
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Zofran, Benadryl, iron supplement, b12 supplement. Calciium w/D supplement List from outside provider: ? azelastine (ASTELIN) 137 mcg (0.1 %) nasal spray Spray 2 sprays into each nostril 2 (two) times a day Use in each nostril as
Current Illness: Ongoing eval by allergy for wretching. All testing negative for allergens.
Preexisting Conditions: Allergic rhinitis ? Anemia ? Back pain ? Bariatric surgery status ? Cholelithiasis ? Contusion of left foot 1/14/2019 ? Iron malabsorption 1/25/2019 ? Menorrhagia with regular cycle 1/25/2019 ? Migraine ? Morbid obesity ? PPD positive ? Sinusitis ? Upper airway resistance syndrome ? Vitamin deficiency
Allergies: Amoxicillin and codeine: flushing and throat "tightness." Black pepper, peppers, spices, tetanus toxoid: nausea/wretching. Never required Epinephrine
Diagnostic Lab Data: After first dose Tryptase normal. ckit normal. Has f/u with allergist.
CDC Split Type:

Write-up: Pt had similar reaction after first dose (see Vaers#77903 from 4/24/2021). Pt was cleared by two allergists. All testing reportedly negative for sensitivity. Advised to premedicate 1 hour prior with 8mg PO Zofran and 50mg PO Benadryl. Pt reported taking one hour prior as ordered. Immediately after vaccination, pt started belching and eventually wretching. Immediately transported to ER where she was given IV NS, IV pepcid 20mg and IV Benadryl 25mg. ER staff discussed with allergist and did not require steroids or epinephrine. Pt discharged after 5 hours observation.


VAERS ID: 1332447 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Injection site bruising, Injection site erythema, Injection site pain, Injection site rash, Muscle fatigue, Muscular weakness, Rash erythematous
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: A week after my vaccination, I have a subtle red rash and bruise still visible at the injection site. My arm muscle feels tired and week and almost a burning sensation. This sesatikn started with the rash. I did feel sore the day after my shot and these new symptoms didn?t start til later.


VAERS ID: 1332458 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Headache, Heart rate, Injection site pain, Oxygen saturation, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MEDROXYPROGESTERONE ACETATE; ESTRADIOL
Current Illness:
Preexisting Conditions: Comments: No history of cardiovascular disease, stroke or prior Heparin use.
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: 102 degrees; Test Date: 20210516; Test Name: Body temperature; Result Unstructured Data: 99.4; Test Date: 20210516; Test Name: Body temperature; Result Unstructured Data: 97.2 degrees; Test Name: Pulse rate; Result Unstructured Data: 71; Test Name: Oxygen saturation; Result Unstructured Data: 97 %; Test Name: Body temperature; Result Unstructured Data: 98.3; Test Name: Blood pressure; Result Unstructured Data: 132/82
CDC Split Type: USJNJFOC20210532643

Write-up: GENERALIZED ACHES; FEVER; INJECTION SITE SORENESS; HEADACHES; This spontaneous report received from a patient concerned a 57 year old female. The patient''s weight was 248 pounds, and height was 160.02 centimeters. The patient''s pre-existing medical conditions included no history of cardiovascular disease, stroke or prior heparin use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. Concomitant medications included estradiol, and medroxyprogesterone acetate. On 15-MAY-2021, the subject experienced headaches. On 15-MAY-2021, the subject experienced injection site soreness. Laboratory data included: Body temperature (NR: not provided) 102 degrees. Treatment medications included: acetylsalicylic acid. On 15-MAY-2021 17:30, the subject experienced fever. On 16-MAY-2021, Laboratory data included: Body temperature (NR: not provided) 97.2 degrees, 99.4. On an unspecified date, the subject experienced generalized aches. Laboratory data (dates unspecified) included: Blood pressure (NR: not provided) 132/82, Body temperature (NR: not provided) 98.3, Oxygen saturation (NR: not provided) 97 %, and Pulse rate (NR: not provided) 71. The action taken with covid-19 vaccine was not applicable. The patient recovered from fever, was recovering from headaches, and the outcome of injection site soreness and generalized aches was not reported. This report was non-serious.


VAERS ID: 1332476 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 27A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pain, Palpitations, Pyrexia, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies and was not taking any medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210533920

Write-up: BODY PAIN; HEART PALPITATIONS; VAGINAL BLEEDING; FEVER; This spontaneous report received from a patient concerned a 26 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies and was not taking any medications. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 27A21A, expiry: UNKNOWN) dose was not reported, administered on 12-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced body pain. On 15-MAY-2021, the subject experienced heart palpitations. On 15-MAY-2021, the subject experienced vaginal bleeding. On 15-MAY-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fever, body pain, heart palpitations, and vaginal bleeding. This report was non-serious.


VAERS ID: 1332969 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Feeling hot, Hyperhidrosis, Migraine, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: Allergy to antibiotic; Drug allergy; Rheumatoid arthritis
Preexisting Conditions: Medical History/Concurrent Conditions: Fibromyalgia; Intervertebral disc compression; Irritable bowel syndrome; Post-traumatic stress disorder; Rotator cuff repair
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: 97.2 F
CDC Split Type: USJNJFOC20210533264

Write-up: EXHAUSTION; MIGRAINE; BODY WARMTH; SWEATING; GENERALISED ACHING; This spontaneous report received from a patient concerned a 43 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included fibromyalgia, compressed l side, s/p rotator cuff surgery (r) shoulder, post-traumatic stress disorder, and irritable bowel syndrome, and concurrent conditions included rheumatoid arthritis, amoxicillin and ceftin allergy, and trazadone allergy.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. Concomitant medications included oxycodone/paracetamol for body temperature increased to 97, and2 f. On 15-MAY-2021, the subject experienced migraine. On 15-MAY-2021, the subject experienced body warmth. On 15-MAY-2021, the subject experienced sweating. On 15-MAY-2021, the subject experienced generalised aching. Laboratory data included: Body temperature (NR: not provided) 97.2 F. On 17-MAY-2021, the subject experienced exhaustion. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from migraine, body warmth, and sweating on 17-MAY-2021, and was recovering from exhaustion, and generalised aching. This report was non-serious.


VAERS ID: 1333182 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-05-15
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough infection


VAERS ID: 1333543 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


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